Coding Compliance Auditor/Educator

MemorialCare•Fountain Valley, CA

17h•Hybrid

About The Position

The Coding Compliance Auditor/Educator reports to the Coding Compliance Supervisor and supports professional services coding compliance, auditing, education, and quality assurance across hospital-based and ambulatory settings. This role helps ensure coding accuracy, regulatory compliance, operational efficiency, appropriate reimbursement, and ongoing staff and provider education. The position serves as a subject-matter expert and operational resource for coding staff, providers, and revenue cycle partners while promoting a culture of quality, accountability, and continuous improvement across professional billing environments.

Requirements

A minimum of 5 years of professional medical coding experience is required, preferably in a professional billing environment that includes multispecialty, ambulatory, hospital-based, or provider-based services.
Experience with professional billing coding in both hospital-based and ambulatory settings is strongly preferred, including E/M coding, procedural coding, modifier usage, payer edits, coding denials, documentation improvement, provider education, audit response, and specialty-specific coding across multiple specialties.
Experience working in an Epic EHR and professional billing environment is strongly preferred, including experience with Epic coding work queues, charge review, claim edits, reporting, dashboards, encounter correction workflows, and collaboration with system support or revenue integrity teams.
Active AAPC CPC or AHIMA CCS-P certification.

Nice To Haves

An associate or bachelor’s degree in health information management, healthcare administration, or a related field is preferred.
Preferred additional certifications may include CPMA, CEMC, CRC, CCS, RHIT, RHIA, or other specialty coding, auditing, compliance, or provider education credentials relevant to professional services coding.

Responsibilities

Support professional services coding for hospital and ambulatory encounters, including office/clinic visits, inpatient and observation professional services, emergency department professional services, procedures, surgeries, diagnostic services, and other physician or qualified health care professional services.
Ensure accurate CPT, ICD-10-CM, HCPCS Level II, modifier, E/M, and place-of-service assignment based on documentation, payer rules, regulatory requirements, and applicable coding guidelines.
Develop, coordinate, and deliver coder and provider education related to professional services documentation and coding, including E/M selection, medical decision making, timebased coding when applicable, split/shared or team-based services, modifier usage, medical necessity, specialty-specific coding, annual code set updates, and payer policy changes.
Collaborate with providers, practice leadership, hospital-based departments, ambulatory clinic teams, revenue cycle, compliance, CDI, HIM, revenue integrity, billing, and system support teams to resolve documentation, coding, charge capture, and reimbursement issues impacting professional services claims.
Maintain current knowledge of applicable federal, state, payer, and organizational requirements, including CMS guidance, OIG compliance expectations, CPT, ICD-10-CM, HCPCS, E/M documentation standards, payer policies, and internal coding compliance standards.
Utilize Epic reporting tools, dashboards, work queue metrics, audit data, denial trends, productivity reports, and coding quality indicators to monitor team performance, identify trends, support operational decision-making, and drive process improvement.
Collaborate with Epic system support, revenue integrity, billing, compliance, clinical operations, CDI, HIM, provider leadership, and practice leadership to evaluate coding-related system functionality, documentation tools, charge capture logic, claim edits, templates, preference lists, SmartTools, order-to-charge workflows, payer rule changes, annual coding updates, testing, and implementation of workflow enhancements.
Develop, maintain, and support coding audit governance processes, including audit methodology, sampling approach, documentation of findings, provider and coder feedback, corrective action plans, follow-up audits, trend reporting, and timely escalation of potential compliance risks through appropriate channels.
Identify, research, document, and escalate professional coding compliance concerns, including documentation insufficiency, modifier misuse, E/M leveling concerns, medical necessity issues, payer policy interpretation, bundling or unbundling risk, upcoding or downcoding risk, duplicate billing, under-coding, over-coding, claim edit trends, denial patterns, and other professional billing risk areas.
Support change management activities related to Epic upgrades, annual code set updates, payer policy changes, new providers, new specialties, new service lines, integrations, acquisitions, workflow redesign, and implementation of coding-related operational changes.
Ensure appropriate access, use, handling, and protection of protected health information within Epic and related coding, billing, reporting, and audit systems in accordance with HIPAA, organizational privacy standards, and information security requirements.
Performs other duties as assigned to support coding compliance, education, audit, and revenue cycle operations.